Mail the completed form to the edd in the envelope provided. Submit your claim no earlier than the first day your family leave begins but. In order to be eligible, you must be unable to do regular work for at least 8 days, be employed or actively looking for work at the time of the disability, have lost wages due to the disability, andor be under the care or treatment of a licensed physician. You should carefully decide the date you want your claim to begin because it may affect your benefit amount. This is for answered by a verified california employment lawyer we use cookies to give you the best possible experience on our website. An example is provided of a claim for paid family leave pfl benefits form for individuals claiming benefits to provide care or bonding. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no. Visit accessibility if you need reasonable accommodation or an alternative format to access information on our website. Claim for paid family leave pfl benefits f part a statement of claimant care or. Employees complete this form if they need to file a disability claim from an on the job injury so that they may receive insurance benefits through their employer. It is also known as a claim for disability insurance benefits claim statement of employee. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no software. Start a free trial now to save yourself time and money. To complete forms, you may need to download and save them on the computer, then open them with the nocost adobe reader.